Thoracic lumbar sacral orthosis

ABSTRACT

A thoracic lumbar sacral orthosis includes an upper body support for use with a torso orthosis. The upper body support has an anterior assembly including an anterior plate secured to the torso orthosis, a sternal assembly connected to the anterior plate, and a pectoral assembly connected to the sternal assembly. A posterior assembly is connected to the torso orthosis and is connected to the pectoral assembly by at least one strap. The sternal assembly has at least one pivot point arranged to pivot the sternal assembly relative to the anterior plate.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority from U.S. provisionalapplication Nos. 61/323,414, filed on Apr. 13, 2010, and 61/258,078,filed on Nov. 4, 2009.

FIELD OF ART

The application relates generally to an orthopedic device, and moreparticularly to thoracic lumbar sacral orthosis and methods forinstalling the same on a wearer.

BACKGROUND

Spinal orthoses are used to treat a variety of conditions associatedwith the skeletal structure, including such conditions as osteoporosis,back injuries, chest injuries and spinal deformities, by applyingpressure to selected positions along the wearer's spine, abdomen andtorso. There are different types of spinal orthoses typicallycategorized by the vertebral level intended for treatment. Spinalorthoses include the sacral orthosis (SO), lumbosacral orthosis (LSO),and the thoraccolumbosacral or thoracic lumbar sacaral orthosis(“TLSO”).

The TLSO is designed to provide support and immobilization of thethoracic and lumbar regions following various traumatic injuries orsurgical procedures. Indications for use of a TLSO include post-surgicalimmobilization, herniated disc, spinal stenosis which occurs when thespinal canal narrows and compresses the spinal cord and nerves,spondylolisthesis which occurs due to anterior displacement of avertebra or the vertebral column in relation to the vertebrae below,spondylolysis or defects of the vertebra, compression fractures, anddegenerative spinal pathologies such as osteoporosis.

A variety of different types of TLSO are known in the art. Many TLSO mayinclude flexion control, sagittal control, saggital-coronal control, andtriplanar control such that as a person attempts right or left rotationof the thoracic spine, counterforces from the thoracic band and thesubclavicular extension limit motion. There are both commerciallyavailable TLSO products, and custom-fabricated TLSO types constructedtypically from a rigid thermoplastic to form a body jacket.

While either commercially available or custom orthoses devices exist,many of these orthoses are found to be uncomfortable to the wearer anddifficult to apply. With commercially available TLSO products, some havethe tendency to poorly fit the contours of the wearer, including thespine, which results in an ill-fitting TLSO and ineffectively supportsthe spine. Many TLSO types, particularly custom-fabricated body jackets,are poorly ventilated and lack sufficient padding. They also lackversatility to enable step-up or step-down treatment of the wearerduring the course of treatment. Furthermore, many TLSO products andcustom orthoses are not adaptable to provide different forms of control,and are limited to a single type of control.

SUMMARY

In accordance with an embodiment of the invention, a thoracic lumbarsacral orthosis includes an upper body support for use with a torsoorthosis, such as a lumbar sacral orthosis, securable about the waistand lumbar region of a wearer. The upper body support has an anteriorassembly including an anterior plate secured to the torso orthosis, asternal assembly connected to the anterior plate, and a pectoralassembly connected to the sternal assembly. A posterior assembly isconnected to the torso orthosis and is connected to the pectoralassembly by at least one strap. The sternal assembly has at least onepivot point arranged to pivot the sternal assembly relative to theanterior plate.

According to an embodiment of the sternal assembly, the sternal assemblyhas at least two pivot points. The pivot points may be defined by lowerand upper hinges. A connecting bar is provided between and links thelower and upper hinges to one another. Preferably, each of the hinges islockable at an angle relative to the connecting bar. From thisarrangement of the sternal assembly, the lower hinge is arranged to biasaway from the wearer's sternum and the upper hinge is arranged to biastowards the pectoral assembly toward the wearer's chest.

An embodiment of the anterior assembly includes a vertical strut that isslidably secured to the anterior plate at a plurality of predeterminedlocations, and connects the sternal assembly to the anterior plate. Theanterior plate may be connected to the torso orthosis by a strap loop.The anterior plate is movable relative to the torso orthosis by thestrap loop.

In an embodiment of the pectoral assembly, the pectoral assemblyincludes a base part, and first and second arms pivotally mounted to thebase part. The first and second arms pivot relative to the base part.The first and second arms may extend obliquely relative to the verticalstrut. A ball and joint connection may connect the at least one arm tothe pectoral pad so that the pectoral pad is pivotable relative to thepad. At least one rotatable bracket may be attached to the pectoral padand be arranged to carry the at least one strap.

According to an embodiment of the posterior assembly, the posteriorassembly includes a support bar connected to the torso orthosis. Thesupport bar includes rotatable brackets attached thereto, and the atleast one strap connects to the posterior assembly via the rotatablebrackets to the anterior assembly.

In another embodiment of the posterior assembly, the posterior assemblyincludes a posterior plate connected to the torso orthosis, and asupport panel having an elongate segment adjustably secured to theposterior plate at a plurality of locations. The support panel definesarms extending from the elongate segment such that the arms aresecurable to the at least one strap connecting to the pectoral assembly.The at least one strap secures to the pectoral assembly, and extendsthrough a slot formed on one of the arms of the support panel, andsecures to the torso orthosis. The support panel may be contoured with aspinal portion and a pair of shoulder portions.

The support panel may have a plurality of location points for connectionto the posterior plate. The location points may be arranged in avertical array thereby providing height adjustment of the support panelrelative to the posterior plate.

The TLSO in accordance with this disclosure has an anatomical designthat follows the contours of the spine, so as to ensure betterimmobilization and patient comfort. The anterior plate, posterior plateand support panel are provided with ventilation for maximumbreathability, and patient compliance by incorporating aerospacer liningand ventilated panels.

Because the upper body support connects to an existing LSO or torsoorthosis, the upper body support can be removed after the wearer nolonger has need for support by a TLSO. This results in a modular systemthat enables the upper body support to applied to the torso orthosiswhen needed, or likewise removed when needed. This results in a step-upand step-down treatment option.

BRIEF DESCRIPTION OF THE DRAWINGS

The inventive orthosis is described with reference to the accompanyingdrawings which show preferred embodiments according to the orthosisdescribed herein. It will be noted that the orthosis as disclosed in theaccompanying drawings is illustrated by way of example only. The variouselements and combinations of elements described below and illustrated inthe drawings can be arranged and organized differently to result inembodiments which are still within the spirit and scope of the orthosisdescribed herein.

FIG. 1 is a perspective view of a thoracic lumbar sacral orthosisaccording to an embodiment of the invention.

FIG. 2A is a front elevational view of the anterior assembly in FIG. 1.

FIG. 2B is a rear sectional elevational view showing the anterior plateof FIG. 2.

FIG. 3 is a side elevational view of an embodiment of the sternalassembly of FIG. 1.

FIG. 4 is a side elevational view of an embodiment of the pectoralassembly in FIG. 1.

FIG. 5 is a front elevational view of a variation of a pectoral assemblyin FIG. 1.

FIG. 6 is a front elevational view of an embodiment of a posteriorassembly.

FIG. 7 is a schematic elevational view of a variation of the posteriorassembly in FIG. 6.

FIG. 8A is a front elevational view of another embodiment of a posteriorassembly.

FIG. 8B is a perspective view showing a strapping system on an anteriorportion of a wearer for use with the posterior assembly according toFIG. 8A.

FIG. 8C is a detailed perspective view showing the strapping systemaccording to FIG. 8B.

FIG. 8D is a perspective view showing a strapping system on a posteriorportion of a wearer for use with the posterior assembly according toFIG. 8A.

FIG. 8E is a perspective view showing a lower, rear portion of theposterior assembly in FIG. 8A connected to a posterior plate.

FIG. 8F is a perspective view showing an inflatable pad for use incombination with the posterior assembly and posterior plate according toFIG. 8E.

FIG. 9 is a schematic view showing attachment of the outer side of theanterior shell of the thoracic assembly in FIG. 1 to a lumbar sacralorthosis.

FIG. 10 is a schematic view showing another view of attachment of thethoracic assembly in FIG. 9 to a lumbar sacral orthosis and showing theinner side of the anterior shell.

FIG. 11 is a schematic view of a strap mounted on a lumbar sacralorthosis for connecting to the anterior plate or posterior plate of thethoracic assembly in FIG. 1.

FIGS. 12A-12C are perspective views of a wearer installing the thoraciclumbar sacral orthosis according to the embodiment of FIG. 1 in a firststrap configuration.

FIGS. 13A-13D are perspective views of a wearer installing the thoraciclumbar sacral orthosis according to the embodiment of FIG. 1 in a secondstrap configuration.

FIGS. 14A-14C are perspective views of a wearer installing the thoraciclumbar sacral orthosis according to the embodiment of FIG. 1 in a thirdstrap configuration.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

A. Overview

A better understanding of different embodiments of the invention may behad from the following description read in conjunction with theaccompanying drawings in which like reference characters refer to likeelements.

While the disclosure is susceptible to various modifications andalternative constructions, certain illustrative embodiments are shown inthe drawings and are described below in detail. It should be understood,however, that there is no intention to limit the disclosure to thespecific embodiments disclosed, but on the contrary, the intention is tocover all modifications, alternative constructions, combinations, andequivalents falling within the spirit and scope of the disclosure.

It will be understood that, unless a term is expressly defined in thispatent to possess a described meaning, there is no intent to limit themeaning of such term, either expressly or indirectly, beyond its plainor ordinary meaning

Any element in a claim that does not explicitly state “means for”performing a specified function, or “step for” performing a specificfunction, is not to be interpreted as a “means” or “step” clause asspecified in 35 U.S.C. §112, paragraph 6.

The embodiments of the disclosure are particularly adapted for a humanbody, and may be dimensioned to accommodate different types, shapes andsizes of human body sizes and contours. For explanatory purposes, theorthosis embodiments described herein are referred to as correspondingto different sections of a body and are denoted by general anatomicalterms for the human body.

The embodiments of the orthosis are particularly referred to ascorresponding to anterior and posterior body sections by ananterior-posterior plane. The anatomical terms described herein are notintended to detract from the normal understanding of such terms asreadily understood by one of ordinary skill in the art of orthotics.

B. Various Embodiments of the Orthopedic Device and Components for UseTherewith

In observing the embodiment according to FIG. 1, a wearer is shownwearing a thoracic lumbar sacral orthosis (TSLO) 10. The TLSO includesan anterior assembly 11 having an anterior plate 12 connected to a torsoorthosis 32, a vertical strut 16 selectively secured to the anteriorplate 12, a sternal assembly 17 connected to the vertical strut 14 andhaving dual pivot points 20, 22, and a pectoral assembly 23 connected tothe sternal assembly and having two pectoral pads 26. Straps 28, 30 areused to secure the pectoral assembly to the chest of the wearer andcouple to a posterior assembly belonging to the thoracic assembly.

While not described herein in any particularity, the torso orthosis 32is preferably a lumbar sacral orthosis (LSO) of the type described inU.S. provisional applications 61/155,843 filed on Feb. 26, 2009 and61/236,649 filed on Aug. 25, 2009, and corresponding U.S. applicationSer. No. 12/713,268, filed on Feb. 26, 2010, all of which areincorporated herein in their entirety by reference. Of course, thethoracic assembly may be adapted to fit a variety of different LSOconfigurations and is not limited to the particular embodimentsdescribed in the aforementioned applications.

As shown in FIGS. 2A and 2B, the anterior plate 12 includes a lockingassembly 14 formed along an elongate central portion of the plate 12.The plate 12 defines a plurality of openings 32 which provide forventilation of the plate against the wearer. The plate 12 is providedwith retaining tabs 34, 42 which retain the vertical strut 16 againstthe plate 12 and which allow the vertical strut 16 to slide relative tothe anterior plate 12.

Particularly in observing FIG. 2B, the anterior plate 12 is providedwith a tab 40 having a locking head 41 mounted at an end portionthereof. The locking head 41 is biased to extend through locking detents38 positioned along an elongate slot 36 formed on the vertical strut 16.The vertical strut 16 is arranged to adjust to a plurality of differentlocations relative to the anterior plate, and the tab allows for simpleadjustment yet maintains the vertical strut in a fixed position withrespect to the wearer's chest when the wearer's torso flexes.

Turning to the sternal assembly 17, as depicted in both FIGS. 2 and 3, adual pivot system is provided. Particularly, the pivot points aredefined by hinges 20, 22 spaced apart by a connecting bar 18. Each ofthe hinges 20, 22 is pivotable and lockable to a particular orientation.The connection members may correspond to the connection membersdescribed in U.S. patent application Ser. No. 12/264,020 filed on Nov.3, 2008, and incorporated herein by reference.

Each of the hinges 20, 24 includes a pair of connection members 72, 76which are arranged to rotate relative to one another about a pivot point64. Each pair of the connection members is also lockable 74 so as toretain the connection members at an angle 65 relative to one another. Inorder to provide relative free rotation of the first and secondconnection members 72, 76 prior to locking the connection members at theangle 65 relative to one another, a biasing member (not shown), such asa spring, is provided between holes formed on corresponding connectionmembers to bias the connecting members away from each other.

The sternal assembly 17 connects to the vertical strut 16 via a slotformed on a lower end of the lower hinge 20, and the pectoral assembly24 connects to the sternal assembly 17 via a slot 78 formed on an upperend of the upper hinge 22 and a stem 48 extending from the pectoralassembly 24. The lower and upper hinges 20, 22 secure to the connectingbar 18 via a slot 68 formed at an upper end of the lower hinge 20, andvia a slot 70 formed at the lower end of the upper hinge 22.

The hinges 20, 22 may be covered with a generally soft overmoldedmaterial so as to avoid or minimize any pressure on the wearer'ssternum. Likewise, the hinges are fully adjustable so as to modify theangle at which the connecting bar is positioned so as to alleviatepressure on the sternum.

In returning to FIG. 2, the pectoral assembly 24 is shown as includingthe stem 48 connecting to the sternal assembly 17, a pair of arms 49A,49B extending obliquely from the stem 48, and a pair of pectoral pads26A, 26B pivotally mounted to end portions of corresponding arms 49A,49B. Each of the pectoral pads 26A, 26B includes padding material 84,and a plurality of ventilation openings.

Rotatable strap brackets or D-rings 51, 53 are mounted about each of thepectoral pads 26A, 26B and permit the connection of straps thereto. Thebrackets 51, 53 may be slidably removable from the pectoral pads 26A,26B via means such as keyhole openings. Moreover, the brackets 51, 53may be formed as quick-release buckles which are arranged to secure tocorresponding structure carried by straps connecting to a posteriorassembly of the thoracic assembly. The brackets may form a key-hole slot55 to allow for easy removal from the end portions of the arms 49.

Referring to FIG. 4, the pectoral assembly 24 is shown with the arm 49having a bent portion 82 which biases an end portion defined by a ball52 into a socket 57 defined by the pectoral pad 26 and secures therewithby a snap fit provided in part by biased openings 80 formed on thepectoral pad. The ball and socket joint permits the pectoral pad toadjust as the wearer moves so as to provide greater comfort and toaccommodate movement. Moreover, due to the removability of the pectoralpads, a variety of pectoral pads may be employed which have differentsizes or shapes to fit a variety of chest anatomies.

FIG. 5 shows a variation of the pectoral assembly wherein a pair of arms56, 58 are pivotally connected to a stem 54. The arms 56, 58 may beadjusted relative to one another and the stem 54, so as to accommodate avariety of chest anatomies. A locking device 60 connects the arms 56, 58to the stem 54 so as to lock an angular configuration of the arms to aparticular wearer.

Turning to FIG. 6, an embodiment of a posterior assembly 100 illustratedfor use with the embodiments of the anterior assembly described herein.According to this embodiment, the posterior assembly 100 includes aposterior plate 102 having an anatomical contour and is adapted tosecure to the torso orthosis. The posterior plate 102 defines aplurality of ventilation openings and a cover 118 that may be placedthereover carrying a cushion element. Mounting pads 119, such as thosebelonging to a hook and loop system, are also located on the posteriorplate for securing to the torso orthosis.

A posterior strut or support bar 104 secures to the posterior plate 102,and defines an elongate center portion 105 and arms 106A, 106B which aremounted onto the posterior plate 102. An upper mount 110 secures to anupper portion 108 of the posterior strut 104, and carries rotatablebrackets or D-rings 112A, 112B for securing to straps.

In a variation shown in FIG. 7, a lateral bar 114 is secured to theupper portion 108 of the posterior strut 104, and carries rotatablebrackets or D-rings 116A, 116B for securing to straps.

While the posterior strut 104 is shown as being rigidly secured to theposterior plate, meaning that it is not adjustable, the posterior plateand strut may be configured similarly to the anterior plate and anteriorstrut shown in FIG. 2 in that the posterior strut is slidablypositionable on the posterior plate at a plurality of predeterminedlocations.

In another embodiment of the posterior assembly, FIG. 8A shows aposterior assembly 136 including a contoured posterior plate or panel138 similar to the posterior plate 102. In this embodiment, a supportpanel 140 connects to the posterior plate 138 via a series ofincremental slots 152 formed on an elongate segment (141) defined by thesupport panel 140 and locking tabs 144 formed on the posterior plate 138or rivets removably securable to the posterior plate. This arrangementallows for adjustment in height of the support panel 140 relative to theposterior plate 138.

The support panel 140 includes a pair of arms 142A, 142B which carry endportions 146 adapted to secure to straps 148, 150.

The support panel may be initially molded flat and then subsequentlymolded so as to reach over the shoulders, in particular the end portions146 of the arms. It is noted that the support panel 140 is wider thanany of the struts described herein and serves to better distributepressure over the back and shoulder of the wearer. In addition, thesupport panel may have an elongate concave contour 145 so as to providespace and contour to the spinal column of the wearer.

Suitable padding 151 may be applied to portions of the support panel,and may likewise be applied to portions of the anterior shell.

Turning to FIGS. 8B-8D, the posterior assembly 136 may be used with astrapping system 141. The end portions 146 of the arms 142A, 142B bendat locations 157 to embrace the shoulder of the wearer, and extend overfrom the back of the wearer to the frontal portion of the shoulder. Theend portions 146 define a slot 147 that is used to receive straps 148,150 connected to the arms of the thoracic assembly. A padding feature159 is secured to each of the straps and is intended to underlie thefrontal portion of the shoulder, and extend underneath the wearer'sarmpit.

As particularly shown in FIGS. 8B and 8D, a first segment 153 of thestraps 148, 150 begin at the thoracic assembly and extend upwardly tothe slots 147 whereat a second segment 150 of the straps is directeddownwardly extend underneath the armpit of the wearer. The segments 150extend downwardly toward the support panel 140 and intersect atintersection point 165 that is located generally within the width of thesupport panel 140 and at the periphery of the torso orthosis 32. Fromthe intersection point 165, strap segments 163A, 163B are drawn to thefrontal aspect of the torso orthosis 32. The strap segments 163A, 163Bhave end portions 173A, 173B which secure to the torso orthosis 32 viafasteners, such as with hook fasteners if the outer portion of the torsoorthosis has loop or hook receiving material.

FIG. 8E shows the support panel 140 secured to a posterior plate 138 viathe slots 152 and locking tabs 144. The posterior plate 138 may includea textile cover to guard it from wearer or to provide greater comfort tothe wearer.

FIG. 8F depicts an inflatable pad 167 that may be used in combinationwith the posterior plate 138. The pad 167 is provided with suitableinflation means, such as with a pump 169 allowing the wearer toselectively inflate the pad to a suitable pressure. The pad 167 has aperiphery 173 that generally corresponds to the shape of the posteriorplate 138. Suitable fastening means, such as a hook and loop system 175,may be used to secure the pad 167 to the posterior plate or the cover ofthe posterior plate.

In accordance with variations of the TLSO according to the disclosure,only a posterior plate may serve as the posterior assembly, withsuitable strapping configurations attached either directly to theposterior plate or to the torso orthosis.

Referring to FIGS. 9 and 10, the torso orthosis 160 is shown having abelt end portion 161 including attachment pads 162 belonging to a hookand loop system. A strap 166 forming a loop is secured to the belt endportion 161 by a rivet 164. The strap 166 feeds through slots 170 formedon the support panel 12 so as to loosely retain the anterior shell 12relative to the belt end portion 161. To fully secure the anterior shell12 to the belt end portion 161, the anterior shell includes attachmentpads 172 which engage and removably secure to the attachment pads 162.

According to the variation shown in FIG. 11, a strap 190 may have afirst end 192 stitched or fastened to the belt end portion 161 and asecond end 194 removably secured to the belt end portion 161. It followsthat the second end 194 feeds through the slots formed on the anteriorshell and is secured to the belt end portion via fastening means such ashook and loop.

It will be noted that the posterior assembly may be secured to the torsoorthosis in any of the aforementioned methods described in connectionwith the anterior assembly.

In accordance with the embodiments described herein, the TLSO isadjusted to the shape and size of the wearer. An initial step is toadjust the height of the anterior assembly by moving the anterior strutrelative to the anterior plate, and locking the anterior strut inposition to the anterior plate. A subsequent step is to adjust the pivotpoints at the lower and upper hinges. The lower hinge is arranged tomove away from the chest and the upper hinge is arranged to draw thepectoral plates tightly against the chest of the wearer. Once configuredfor the patient, any additional adjustments can be conducted accordingto the aforementioned steps to assure a proper, secure fit.

The pectoral pads are arranged to be rotated away and toward one anotherdepending on the width and height of the chest. Advantageously, thepectoral pads are separated from one another by the arms so as toprevent them from striking the throat of the wearer upon sitting down.Overall, this configuration avoids the common problem in many TLSOproducts of the orthosis structure riding up on the wearer's bodyaccording to the wearer's position.

The TLSO is arranged to allow for a variety of different strappingconfigurations.

In a first strapping configuration, as exemplified by FIGS. 12A-12C,shoulder straps are secured to brackets on the posterior assembly. Thestraps are pulled over the wearer's shoulder and carry quick releasebuckles. The wearer can adjust the length of the strap which may be doneby hook and loop material provided at an end portion of the straps.

A second strapping configuration does not require the anterior assembly.Shoulder straps are secured to brackets on the posterior assembly andthese straps are typically longer straps than are used in the firstconfiguration. The straps are crossed over the wearer's shoulder andtightly pulled back toward the wearer's posterior waist. The straps arethen crossed in the back of the wearer and subsequently attached to thefront of the wearer's anterior waist.

In a third strapping configuration, the shoulder straps connect theposterior assembly to the anterior assembly as in the first strappingconfiguration. In addition, chest straps are provided and secure to anadditional set of brackets mounted on the pectoral assembly, and on theposterior assembly as shown in FIG. 7. The chest straps are subsequentlytightened.

These strapping configurations are merely exemplary, and additionalconfigurations may be employed.

The embodiments of the TLSO provide significant advantages forimmobilizing a wearer. For example, the anterior thoracic extensionachieved in part by the vertical strut 16, when connected to theanterior rigid panel or plate 12, offers saggital plane immobilizationagainst thoraco-lumbar flexion. The posterior thoracic extensionrealized by the posterior assembly, when connected to the support panelthrough the locking tabs, and with anterior extension with the shoulderstraps, offers additional saggital plane immobilization of both thethoraco-lumbar flexion and extension.

Another advantage, at least from the strapping system according to theembodiments of FIGS. 8A-8D, the straps further enhance triplanarthoraco-lumbar immobilization through (1) maximal sagittal planeimmobilization in both flexion and extension, coronal planeimmobilization which inhibits thoraco-lumbar lateral bending, andtransverse plane immobilization of thoraco-lumbar rotation. Thestrapping system also offers improved immobilization of the upper thoraxthrough neutral positioning of the shoulders in a retracted position(Shoulders back). This is a key factor in proper posture as well asrotation inhibition of the upper thorax.

While a particular embodiment of an orthopedic device is discussedabove, the components of the orthosis described herein may be formed inany suitable manner recognized by a skilled artisan, such as casting,molding, machining, stereolithography, or any other suitable process.

While a particular torso orthosis has been discussed and shown herein,the anterior and posterior assemblies described herein can be adapted toconnect and operate with a variety of known torso orthosis known tothose skilled in the art. Accordingly, the anterior and posteriorassemblies described herein are not limited for use with the exemplarytorso orthosis.

As is readily apparent from the foregoing discussion, it is understoodthat the size of the orthosis and the components thereof can be adjustedso that a large number of different users having different sized jointsand body parts may benefit from the present design.

It is also understood that the locations of the various connectionpoints can be alternated from those shown, such that the connectionpoints may be altered from the positions as illustrated herein.

Of course, it is to be understood that not necessarily all objects oradvantages may be achieved in accordance with any particular embodimentof the invention. Thus, for example, those skilled in the art willrecognize that the invention may be embodied or carried out in a mannerthat achieves or optimizes one advantage or group of advantages astaught herein without necessarily achieving other objects or advantagesas may be taught or suggested herein.

The skilled artisan will recognize the interchangeability of variousdisclosed features. In addition to the variations described herein,other known equivalents for each feature can be mixed and matched by oneof ordinary skill in this art to construct an orthosis in accordancewith principles of the present invention.

Although this invention has been disclosed in the context of certainexemplary embodiments and examples, it therefore will be understood bythose skilled in the art that the present invention extends beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. Thus, it is intended that the scope of the present inventionherein disclosed should not be limited by the particular disclosedembodiments described above.

1. An upper body support for use with a torso orthosis securable to awearer, the upper body support comprising: an anterior assembly havingan anterior plate secured to a torso orthosis, a sternal assemblyconnected to the anterior plate, the sternal assembly having at leastone pivot point arranged to pivot the sternal assembly relative to theanterior plate, and a pectoral assembly connected to the sternalassembly; and a posterior assembly connected to a torso orthosis, theposterior assembly connected to the pectoral assembly by at least onestrap.
 2. The upper body support according to claim 1, wherein thesternal assembly includes at least two pivot points.
 3. The upper bodysupport according to claim 2, wherein the pivot points are defined bylower and upper hinges and a connecting bar provided between and linkingthe lower and upper hinges.
 4. The upper body support according to claim3, wherein each of the hinges is lockable at an angle relative to theconnecting bar.
 5. The upper body support according to claim 3, whereinthe lower hinge is arranged to bias away from a wearer's sternum and theupper hinge is arranged to bias towards the pectoral assembly toward awearer's chest.
 6. The upper body support according to claim 1, whereina vertical strut is slidably secured to the anterior plate at aplurality of predetermined locations, and connects to the sternalassembly to the anterior plate.
 7. The upper body support according toclaim 6, wherein the pectoral assembly includes a base part, and firstand second arms pivotally mounted to the base part, the first and secondarms pivot relative to the base part.
 8. The upper body supportaccording to claim 6, wherein the pectoral assembly defines at least onearm extending obliquely relative to the vertical strut.
 9. The upperbody support according to claim 8, wherein a ball and joint connectionconnects the pectoral pad to the at least one arm, the pectoral padpivotable relative to the at least one arm.
 10. The upper body supportaccording to claim 1, further comprising at least one rotatable bracketattached to the pectoral pad and arranged to carry the at least onestrap.
 11. The upper body support according to claim 1, wherein theposterior assembly includes a support bar connected to a torso orthosis,the support bar including rotatable brackets attached thereto, and theat least one strap connected to the posterior assembly via the rotatablebrackets to the anterior assembly.
 12. The upper body support accordingto claim 1, wherein the posterior assembly includes a posterior plateconnected to a torso orthosis, and a support panel having an elongatesegment adjustably secured to the posterior plate at a plurality oflocations, the support panel defining arms extending from the elongatesegment such that the arms are securable to the at least one strapconnecting to the pectoral assembly.
 13. The upper body supportaccording to claim 12, wherein the at least one strap secures to thepectoral assembly, extends through a slot formed on one of said arms ofthe support panel, and secures to a torso orthosis.
 14. The upper bodysupport according to claim 1, wherein the posterior assembly includes aposterior plate and a support panel adjustably connected to theposterior plate, the support panel contoured with a spinal portion and apair of shoulder portions.
 15. The upper body support according to claim14, wherein the support panel has a plurality of location points forconnection to the posterior plate, the location points arranged in avertical array thereby providing height adjustment of the support panelrelative to the posterior plate.
 16. An upper body support for use witha torso orthosis securable to a wearer, the upper body supportcomprising: an anterior assembly connected to a torso orthosis andincluding a pectoral assembly; a posterior assembly connected to a torsoorthosis; at least one strap having first and second end portions, thefirst end portion anchored to the pectoral assembly, the at least onestrap extending through the posterior assembly, and the second endportion adjustably securing to a torso orthosis.
 17. An upper bodysupport for use with a torso orthosis securable to a wearer, the upperbody support comprising: an anterior plate secured to a torso orthosis;a sternal assembly connected to the anterior plate, the sternal assemblyhaving lower and upper hinges and a connecting bar located between andlinking the lower and upper hinges; a pectoral assembly connected to thesternal assembly; a posterior assembly connected to a torso orthosis,the posterior assembly connected to the pectoral assembly by at leastone strap.
 18. The upper body support according to claim 17, wherein thepectoral assembly includes a base part and first and second armspivotally mounted to the base part, the first and second arms pivotrelative to the base part.
 19. The upper body support according to claim17, wherein the pectoral assembly defines at least one arm extendingobliquely relative to the vertical strut.
 20. The upper body supportaccording to claim 19, wherein the pectoral pad has a ball and jointconnection to the at least one arm such that the pectoral pad ispivotable relative to the pad.